Objective: Pediatric Multisystem Inflammatory Syndrome temporally associated with COVID-19 (PIMS-TS) is a new syndrome characterized by persistent fever, inflammation and evidence of single/multiorgan dysfunction; some of these children are critically ill with shock and multiorgan failure and require intensive care. Neurological manifestations have been reported in children with PIMS-TS, although the pathophysiology is yet to be elucidated. The aim of the study was to evaluate EEGs taken in children with PIMS-TS and correlate with clinical disease-related neurological manifestations.
Methods: In this retrospective case series, twenty-one children who had been admitted to Great Ormond Street Hospital and diagnosed with PIMS-TS, underwent EEGs between 30/03/2020 to 30/07/2020 for suspicious of encephalopathy, seizures, or other neurological manifestations. EEGs were interpreted by senior clinical neurophysiologists and abnormalities were classified into five categories ranging from grade 0 (normal) to grade 5 (profound encephalopathy), based on background pattern and reactivity, and considering expected maturation stage. Clinical features were retrieved from electronic patient records and EEG findings were correlated with clinical data.
Results: We included 21 children with a diagnosis of PIMS-TS. Ten were recorded on ICU (47%), and eleven on the ward (53%). All EEGs performed were abnormal: the EEGs performed in ICU ranged from borderline to severe changes while the ones taken on the ward from borderline to moderate changes. We did not identify epileptiform features, rhythmic or periodic patterns, or subclinical/clinical seizures in any of the patients. Follow-up EEGs performed on 16 patients show an improvement trend, resulting in either normalization of the EEG or persistence of borderline/mild changes only. Clinically, all patients were in remission, but persistent behavioral issues were reported in two patients.
Conclusions: This is the first EEG case series in children with a diagnosis of PIMS-TS who developed neurological manifestations. All EEGs showed non-specific abnormalities, and no definite epileptiform features were identified. Clinical and electrophysiological improvement was observed in all patients.